Bill C-14 (Historical)

An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) create exemptions from the offences of culpable homicide, of aiding suicide and of administering a noxious thing, in order to permit medical practitioners and nurse practitioners to provide medical assistance in dying and to permit pharmacists and other persons to assist in the process;
(b) specify the eligibility criteria and the safeguards that must be respected before medical assistance in dying may be provided to a person;
(c) require that medical practitioners and nurse practitioners who receive requests for, and pharmacists who dispense substances in connection with the provision of, medical assist­ance in dying provide information for the purpose of permitting the monitoring of medical assistance in dying, and authorize the Minister of Health to make regulations respecting that information; and
(d) create new offences for failing to comply with the safeguards, for forging or destroying documents related to medical assistance in dying, for failing to provide the required information and for contravening the regulations.
This enactment also makes related amendments to other Acts to ensure that recourse to medical assistance in dying does not result in the loss of a pension under the Pension Act or benefits under the Canadian Forces Members and Veterans Re-establishment and Compensation Act. It amends the Corrections and Conditional Release Act to ensure that no investigation need be conducted under section 19 of that Act in the case of an inmate who receives medical assistance in dying.
This enactment provides for one or more independent reviews relating to requests by mature minors for medical assistance in dying, to advance requests and to requests where mental illness is the sole underlying medical condition.
Lastly, this enactment provides for a parliamentary review of its provisions and of the state of palliative care in Canada to commence at the start of the fifth year following the day on which it receives royal assent.

Criminal Code

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Speaker, that is a good question. It is an issue of timeline. If this bill passes overwhelmingly at second reading, it goes to committee, it comes back with virtually no time left. If the government chooses not to make necessary amendments, it will leave members of Parliament with a much narrower set of options.

I suggest we take a stand against the government, with its bullying effort of closure. Let us take a stand against the big problems in this bill and reject it at this reading stage. There is plenty of time for the government to bring back a new bill if it works to achieve substantial consensus among members of Parliament. However, if we support the legislation at second reading and the bill passes at this stage, we will lose necessary time to do a more fundamental review.

Of course the bill can be amended at committee, but the various things I have advocated are substantial enough that we are better off rejecting it and asking the government to come back with something that is substantially better. It is the only way to send a clear message that the absence of protections for the vulnerable are necessary to ensure that people do not die who should not die. The absence of those protections in this bill is so fundamental that we must vote this bill down until we can be sure they will be included.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, we have heard many extremely poignant statements over the past few days in this chamber. Here are a few of them, not necessarily word for word, but the essence is there: This is by far the most crucial question we have faced in this chamber in the past 10 years. We are experiencing a fundamental shift in society. Centuries of thought are being overturned. Thousands of years of the understanding of the sacred gift of human life are being discarded.

The Liberal member of Parliament for Winnipeg Centre stated:

Perhaps this is just another step on the road of moral relativism that we are in nowadays, but even our judiciary cannot serve as a balance between the different societies making up Canada. We are in a sorry state. We have truly entered a new age, one of the throwaway culture where all boundaries are starting to crumble.

He goes on to say:

From an indigenous perspective, I look at this bill and I cannot support it, because it leads to a place where I do not believe we are looking out for the interests of all people within our society. It is not allowing us to fully comprehend the needs of everyone who makes up Canadian societies, but really, it is taking us down a path that is very dangerous, and we do not know where it ends.

This comment is true not only for our indigenous communities, but also for the overwhelming majority of all Canadians who are informed by their faith, whether that be Jewish, Muslim, Sikh, or Christian.

I want to read from a very insightful blog that I came across today.

...from its very first sentence the bill sounds the final death-knell, for all public purposes, of Abrahamic faith. The Carter/C-14 doctrine of autonomy is a clear repudiation of that kind of faith and the establishment of a new faith in man as utterly independent of God. One does not need to be Abrahamic to understand this. If the Parliament of Canada recognizes personal autonomy as extending a moral right to determine the manner and timing of one’s own death, and to take one’s own life or another’s life, it necessarily recognizes the person—and [Parliament] itself as a deliberative body of persons—as lying outside of all putative divine authority in such matters. In short, the C-14 preamble is the final repudiation of the Charter preamble. “The principles of fundamental justice”...now operate independently of any reference whatsoever to the supremacy of God. The link between “the supremacy of God and the rule of law” is decisively severed.

He then goes on to quote Nietzsche:

What were we doing when we unchained this earth from its sun? Whither is it moving now? Whither are we moving? Away from all suns? Are we not plunging continually? Backward, sideward, forward, in all directions? Is there still any up or down? Are we not straying, as through an infinite nothing? Do we not feel the breath of empty space? Has it not become colder? Is not night continually closing in on us? Do we not need to light lanterns in the morning? Do we hear nothing as yet of the noise of the gravediggers who are burying God? Do we smell nothing as yet of the divine decomposition? Gods, too, decompose. God is dead. God remains dead. And we have killed him.

Over the past few days in the House, we have heard from many members with a wide variety of positions. Let me first say that I am very thankful that the government decided not to follow through with all of the recommendations made in the Liberal-dominated special joint committee report and decided rather to incorporate many of the comments of the dissenting report created by me and other members of the Conservative Party.

While Bill C-14 is a huge improvement from the very permissive, wide-open regime recommended by the joint committee, the legislation falls far short in protecting some of our most vulnerable Canadians, and as a result, I cannot support it.

First, there is no firm commitment to conscience protection for doctors and other health care workers who for a variety of reasons may not want to participate in any fashion in physician-assisted suicide. This includes the need to make a referral to a participating doctor.

While the preamble states boldly that it is “desirable to have a consistent approach to medical assistance in dying across Canada”, and later refers to “respect the personal convictions of health care providers”, there is no section in the actual clauses of Bill C-14, no clear, unequivocal statement that no doctor or health care worker would be under any obligation to participate.

Just as important, what about health care institutions and hospices which, because of the core values they embrace, may not want to have physician-assisted suicide available in their institutions? What about a hospice which raises upward of 50% of its own revenue from private donations and which relies largely on armies of volunteers and donors who believe in the inherent and intrinsic dignity of human life? My fear is that if any of these institutions are forced into situations in which they are obligated to engage in physician-assisted suicide, the community may face the very real possibility of losing those volunteers and donors, and ultimately, may in fact lose the very institution itself. This would be a tragic unintended consequence of not guaranteeing conscience rights to doctors, health care workers, and institutions.

These changes must be included in Bill C-14 if we are to respect the professionals and institutions that provide excellent quality of health care every day.

There also needs to be a clear commitment to providing palliative care as a real and viable option. To offer physician-assisted suicide without a meaningful offer of available and palliative care is to provide no option.

Let me quote Dr. David Baker:

Without a right to palliative care, Canadians will soon be receiving publicly funded physician assistance to die because it [palliative care] is not available. This will infringe their s. 7 Charter right to life, liberty and the security of their persons and their section 15 equality rights as Canadians with disabilities and seniors.

Another important amendment that is needed is to have a system of prior review. There needs to be a legal system in place to ensure that no coercion occurs and to ensure that the two independent witnesses are in fact independent and that the two independent doctors are in fact independent.

Dr. Trudo Lemmens, the chair on health law and policy at the faculty of law at the University of Toronto stated:

...some eligibility criteria are inevitably quite open to interpretation, which makes it all the more problematic that an assessment of competency and informed consent by two physicians is seen as sufficient to ensure compliance. I continue to support a prior review system as reflected in the Vulnerable Person Standard, which is supported by a wide and inclusive coalition of patient and disability advocacy groups, health professional organizations, health care institutions and individuals with a wide variety of ideological and religious affiliations.

While I am fundamentally opposed to the taking of human life at any point, if we are to adopt legislation as a House of Commons, if we are going to go down this road, we need to be sure that we have far more stringent safeguards included in the bill.

[Pierre-Luc Dusseault, NDP, Sherbrooke, QC]

Mr. Speaker, I would like to thank my colleague for his speech and his long-standing work on this issue.

I was wondering if he could acknowledge this evening that a hypothetical new law would provide freedom of choice. People who are dying or whose health is very fragile will always have the option of accessing medical assistance in dying, which is now protected under the charter. These people will always be able to choose that option or continue to live out their days as they do at this time.

Does he acknowledge that, even with a new legislative regime, this does not change the fact that every patient who is dying will always be able to choose whether or not to access this service? Therefore, this respects the conscience of the individuals and their families, but also the freedom of choice and the rights of patients who might want to use this service. Does he acknowledge that under a new legislative regime, patients will always have choice and people will not be forced to use these services?

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, it has been pointed out by a number of my colleagues that while freedom of human choice is a freedom we personally have, when we implement a regime like we are considering here, we are not just choosing for ourselves but we are choosing to have a person, a medical practitioner of some sort, obligated in some fashion to participate in our choice. It is on those points that the House has struggled over these past few days.

The one clear commonality among the concerns that we have expressed is the concern that we need to protect the conscience rights of those medical practitioners who for one reason or another may not wish to participate at all, either directly in implementing a physician-assisted suicide act or in referring to a person who would in fact carry out the patient's wishes.

[Mel Arnold, Conservative, North Okanagan—Shuswap, BC]

Mr. Speaker, the member mentioned that we were going down a path that we may not be able to turn around. He spoke about eligibility as open to interpretation. I wonder about some of the definitions in the bill. What really bothers me is the lack of definitions and the lack of clarity. I would like to know if the member would like to comment on this.

At what point does the suffering become too much? Is it at a point when no one else is suffering worse? By removing or aiding in the assistance of the death of those people who are suffering, does that level of suffering and intolerance become a speeding train which we cannot stop, to where it will be ever increasingly different and we will not be able to control it?

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, my colleague in the Liberal Party, possibly the member for Winnipeg Centre but I am not sure, made a comment the other day, that in the first nations tradition, they always take into consideration how the decision they make today will impact seven generations from now. I thought there was a lot of wisdom in that perspective. Often we look at a decision and we make it lightly without thinking about the long-term consequences. Each of us in this room has made the mistake of making a short-term decision without adequately considering the long-term consequences.

I am very concerned about where we are going with this bill. Many of my colleagues, on both sides of the House, have given illustrations from other jurisdictions that have implemented a regime similar to the one we are considering, in fact in some cases more restrictive than the one we are considering. Yet over time, those jurisdictions have seen an incredible widening of the door, while thinking at first they had adequate safeguards, and in a very short time moving from a smaller number of people accessing physician-assisted suicide to an increase within a period of 15 years, for example, in Belgium I believe, it went from 330 to over 2,200 last year.

If we are to extrapolate those numbers to Canada with a population of three times that of Belgium, we are looking at potentially over 6,000 Canadians dying by physician-assisted suicide in one year. In my opinion, that would be a national tragedy.

[Rob Oliphant, Liberal, Don Valley West, ON]

Mr. Speaker, I have one concern for the member. I just noticed the member for Kitchener—Conestoga and the member for Sherwood Park—Fort Saskatchewan have now spoken repeatedly on this. I am concerned that the members on the other side have begun to run out of steam and are repeating themselves. Maybe the Conservatives do not have enough speakers to continue this debate any further. I wanted to bring it the attention of the House that perhaps the members could talk about the problem of getting new speakers on this subject.

[The Speaker, Geoff Regan]

I am not sure that is a legitimate question in relation to the debate we are having, but I am going to turn to the hon. member for Kitchener—Conestoga, who seems to wish to respond.

[Harold Albrecht, Conservative, Kitchener—Conestoga, ON]

Mr. Speaker, I am more than happy to address that question because I know many members in our party still want to speak to the bill. It just so happens that because of the procedural games that were put in today, there was a question of whether anyone would be able to speak tonight. However, now that we have that opportunity, we have had to do some changing around, but there are still more people who want to speak to the bill.

If members look at the comments I made tonight and the comments of my colleague, they will see that we are not repeating ourselves. We are simply telling members about the concerns we have had, and we certainly would not have had time in the 10 minutes that were available to us earlier.

I appreciate the opportunity to speak again tonight to this very crucial issue. There is no issue that this Parliament will be seized with that is more fundamental, not only to this generation but to future generations of Canadians that will follow. I for one want to be able to stand, look my children, my grandchildren, and my great-grandchildren in the eye and tell them that with the information I had available to me I made the decision that was right for Canada.

[The Speaker, Geoff Regan]

It being midnight, pursuant to order made Tuesday, May 3, 2016, the debate is deemed adjourned and the House stands adjourned until later this day at 2 p.m., pursuant to Standing Order 24(1).

(The House adjourned at 12 a.m.)

The House resumed from May 3 consideration of the motion that Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), be read the second time and referred to a committee, and of the motion that this question be now put.

Second Reading

[Ali Ehsassi, Liberal, Willowdale, ON]

Mr. Speaker, I am grateful for the opportunity to rise today to join many other colleagues in addressing the significant national debate surrounding Bill C-14, and our government's prompt and appropriate response to the Supreme Court's Carter decision. I believe this was a duty the previous government neglected, and I am proud of our government's response to this complex issue.

Bill C-14 represents a mandated response to the Supreme Court's Carter decision by providing a national framework to ensure, subject to necessary safeguards, access to a fundamental and inviolable right enshrined under section 7 of the Canadian charter. After all, the Carter decision transformed the question before the government from one focused on whether the government should legislate and legalized medical assistance in dying to the very different question of how fast to legislate and legalize medical assistance in dying.

Despite the clear contours delineated by the Supreme Court, I would like to acknowledge the hard work of all members of the House over the course of the past several months to contribute to this important national debate by recognizing the crucial role of the Special Joint Committee on Medical Assistance in Dying, and acknowledging the leadership demonstrated by the Minister of Justice and the Minister of Health for introducing this transformative legislation.

I would also like to thank all Canadians who have, in one way or another, participated in nation-wide consultations with their provincial and federal governments. I am very proud that many constituents in my riding of Willowdale took the time to approach me regarding various aspects of this bill, and having listened to them, I realize full well that this is a deeply important issue for many Canadians.

At the centre of the profound and solemn debate that has ensued in the House and elsewhere, have been discussions focused on such foundational principles, such as the need to respect individual rights, equity, consent and capacity, clarity, dignity, and accountability. Yet, given the extensive debate that has occurred in the House, I would like to specifically focus my remarks on two specific aspects of this bill which I believe need to be further highlighted and emphasized.

The first issue I will focus on is that Bill C-14 represents a significant first step that now requires further co-operation with our provincial and territorial partners. Second, it is important to recognize the significant safeguards embedded in Bill C-14.

One of the primary characteristics of charter rights, of course, is equal access. If charter rights are by definition universal, they must, within reason, be equally accessible to all Canadians. This is where I believe Bill C-14 comes into play by establishing a national framework for medical assistance in dying that can ensure equitable access across provinces and territories. I feel that Bill C-14 fulfills an expressed desire by our provincial and territorial governments for a national framework to address this timely issue.

I strongly believe that this legislation provides an opportunity for the federal government to facilitate a collaborative approach, which includes provincial and territorial consultation. Specifically, the bill's own preamble clearly states that the law must apply consistently across all of Canada. As such, this bill advocates for a national framework in order to avoid variations from province to province.

As we all know, the Quebec government has in many ways laid the groundwork for medical assistance in dying with their own provincial legislation. However, while provinces will continue to act as key legislative and administrative partners in medical assistance in dying, I think we can all agree that establishing a pan-Canadian, national approach was crucial.

We should continue to work with the provinces and territories to explore mechanisms to coordinate end-of-life care for patients who want access to medical assistance in dying, thus avoiding crucial gaps in access and delivery.

Furthermore, in keeping with our government's commitment to evidence-based decision-making, we will engage with the provinces and territories to support the development of a pan-Canadian monitoring system to collect and analyze data, monitor trends, and publicly report on medical assistance in dying.

This two-way relationship is important. In other words, Bill C-14 represents the beginning of a partnership on medical assistance in dying. Our provincial colleagues, informed by the framework we have provided, can now begin the process of implementing their own medical assistance in dying regimes. Quebec, of course, has already done so, while Ontario and most other provinces have begun the process through the creation of a PT advisory groups on physician-assisted dying.

Allow me now to shift to the second element I would like to address today, the topic of the safeguards included within Bill C-14.

Bill C-14 makes Canada the ninth jurisdiction in the world to legalize medical assistance in dying, not including Quebec. Fortunately, we have been able to learn from their experiences to implement safeguards that will protect the most vulnerable while also allowing suffering Canadians access to their charter rights. Bill C-14 is, therefore, a carefully and deliberately crafted piece of legislation, which learns from the best practices of other governments to legalize medical assistance in dying.

As the Supreme Court made clear in paragraph 117 of the Carter decision, the risks associated with physician-assisted death can be limited through a carefully designed and monitored system of safeguards. Our government is committed to addressing the task put forth by the Supreme Court. We understand that this is a complex and emotional issue for many Canadians. As a result, we want to ensure that protecting the charter rights of some Canadians does not infringe upon the charter rights of others.

Bill C-14 provides strict criteria outlining precisely who is eligible for medical assistance in dying. Relatively strict guidelines are required when dealing with such a significant issue and eligibility is limited to three prescribed sets of conditions contained in Bill C-14.

Bill C-14 also includes safeguards protecting the personal convictions of health care providers. This is a fact that bears repeating as there seems to be some misunderstanding and confusion surrounding this issue. There is nothing in Bill C-14 that compels any medical practitioner to perform medical assistance in dying against their will.

As the Minister of Justice recently confirmed in her appearance before the Standing Committee on Justice and Human Rights on May 2, 2016, she said:

There is nothing in our legislation that would compel a medical practitioner to perform medical assistance in dying as you point out. The jurisdiction in terms of regulations falls to the provinces and territories.

The Minister of Health also addressed this issue in her remarks before the same committee and apart from reiterating that the issue of the conscience rights of health providers falls within the jurisdiction of the provinces, she confirmed that the federal government is already working with the provinces to develop a care coordination system for end-of-life care.

Finally, I believe the inclusion in Bill C-14 of a five-year review clause is another important safeguard. While I have the utmost confidence that the bill would address the issues presented to the government via the Carter decision, this mechanism would allow for future improvements and modifications, if need be.

Before concluding, allow me to also emphasize that Bill C-14 is part of a larger discussion around end-of-life health care. In that spirit, I am proud of the commitments our government has made toward palliative care, through a much-needed $3-billion investment over four years for home and palliative care.

I am confident that the vast majority of my constituents support medical assistance in dying and support Bill C-14. I urge my colleagues in the House to support the bill as well. By boldly, yet responsibility, reacting to the Carter decision, our government has created a workable and pragmatic national framework that would allow us to closely collaborate with the provinces and territories.

Bill C-14 marks the beginning of a new era. By addressing the expanded charter rights laid out by the Carter decision, this legislation would provide Canadians access to a long-overdue right.

[Guy Lauzon, Conservative, Stormont—Dundas—South Glengarry, ON]

Mr. Speaker, the member mentioned that he was very confident that the majority of his constituents would support his position on Bill C-14. I actually sent a survey to every one of the 45,000 homes in my riding and got the opposite result. As a matter of fact, 65% of the respondents are opposed to Bill C-14 and 35% are in favour of it.

I wonder if he would be willing to do that in his riding just to confirm what he is stating in the House of Commons.

[Ali Ehsassi, Liberal, Willowdale, ON]

Mr. Speaker, of course, the reason I said that is that I have had plenty of opportunities to speak to various constituents. What I can say is that after having spoken to many constituents, they understood the context within which the bill has been adopted. They appreciate full well that the Supreme Court considered this issue. They also understand full well that many consultations went on and that what resulted from those consultations was Bill C-14.

[Dominic LeBlanc, Liberal, Beauséjour, NB]

Mr. Speaker, I rise on a point of order. I am tabling, in both official languages, the government's response to Questions Nos. 80 and 81.